Does Canada have Federated EMR Paralysis?

Will geographic challenges and the decentralized nature of Canadian provinces and territories ultimately be the undoing of any attempts towards a national EMR strategy?

At a time that hard decisions need to be made regarding a national approach to EMR adoption and use, there has never been a greater need for leadership to ensure that sustainable and effective strategies be put in place. However, does the makeup of Canada work against any efforts to create sustainable policies?

Having been involved in numerous provincial and national programs over the past decade, it has been evident to me that any attempts to reach consensus have been fraught with difficulties. Quebec is frequently not at the table in a meaningful way and has the added challenges of the need for French or bilingual EMR solutions. Privacy, instead of functioning as an enabler to develop systems that protect confidential information while allowing the movement of appropriate data between patient and provider, functions as a barrier. [Privacy experts will take exception to this statement - however I witnessed first-hand the inability to share information between regional health authorities in British Columbia without complex information sharing agreements. These entities are theoretically all on the same side].

Australia has taken the novel approach of shifting towards a patient health record (PHR) approach to their national electronic health records strategy. After years of attempting to develop meaningful national policies, they have moved away from the top-down towards the bottom-up approach.

Is it simply the desire in Canada for everyone to be heard or is it the more ominous need for control at the provincial or regional levels that acts as the primary barrier?

As the US puts significant resources behind a committed strategy to enable EMR adoption at the provider level [not without its own challenges], Canada seems frozen and unable to move ahead. Perhaps what we need is a health czar such as Dr. David Blumenthal in the US! What we also need is a recognition that the needs from province to province are not significantly different from an information sharing perspective that we need entirely different versions of EMRs in each province.

Canada is being left behind by the US and is way behind many European countries in terms of the automation of healthcare. If we truly consider ourselves a first-world country, we need to move away from third-world strategies and put effective leadership in charge of the national EMR strategy. Without this, we will never create clinically seductive solutions and Canadian physicians and patients will remain mired in the disorganized world of the hybrid paper and electronic healthcare system.

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Comments

[Andrzej Taramina]

How about we revise the opening statement a bit, to:

"Will geographic challenges and the decentralized nature of the world ultimately be the undoing of any attempts towards a global internet?"

Can you imagine what the internet would have been like if we had left it in the hands of bureaucrats to conceptualize and deliver it? Neither can I...and I wouldn't be posting this comment if that had come to pass either. ;-)

I think the original question is fallacious approach, specifically, one that is driven top down.

If we expect the "powers that be" to resolve the EMR/EHR issues, then I believe that Canada will fail. Miserably. There has been a lot of press recently about the endemic failure of large-scale, government-run healthcare projects for a reason.

As Margaret Mead so aptly said:

"Never doubt that a small group of committed people can change the world.
Indeed, it is the only thing that ever has."

It's how the internet was built. And is likely the only way that EMR/EHR that entails "meaningful use", offers productivity improvements for healthcare professionals and delivers improved patient outcomes with reduced systemic costs, is likely to ever have a chance of seeing the light of day.

My 2 cents worth, as a "committed person". Or maybe one that needs committing? LOL